Masui. The Japanese journal of anesthesiology
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Case Reports
[Anesthetic management of a hyper-obese patient by target-controlled infusion (TCI) of propofol and fentanyl].
We gave total intravenous anesthesia to an over-100% hyper-obese patient using target-controlled infusion (TCI) of propofol and fentanyl. To keep him asleep, we maintained his BIS in a range of 40 to 60 by adjusting the target concentration of propofol. ⋯ The relationship between BIS value and effect-site concentration of propofol was almost the same as that assessed in ordinary adults of a normal weight. We conclude that the estimated concentration of propofol is a good indicator of the effect of propofol and that TCI is a useful technique in obese patients as well as in ordinary adults.
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Randomized Controlled Trial Clinical Trial
[Relationship between minimum alveolar concentration and electroencephalographic bispectral index as well as spectral edge frequency 95 during isoflurane/epidural or sevoflurane/epidural anesthesia].
To investigate the relationship between minimum alveolar concentration (MAC) and electroencephalographic variables, we measured the bispectral index (BIS) and the spectral edge frequency 95 (SEF 95) in 17 patients undergoing elective surgery during isoflurane/epidural (n = 8) or sevoflurane/epidural (n = 9) anesthesia. Patients received 2.0 MAC end-tidal concentrations of isoflurane or sevoflurane, and the BIS and the SEF 95 were recorded after 15 min of an unchanged end-tidal concentration. The concentration of the inhalational agent was decreased to 1.2 MAC, and measurements were repeated again. ⋯ There were significant differences in the BIS and the SEF 95 at 2.0 MAC between isoflurane and sevoflurane groups. In contrast, the BIS and the SEF 95 showed no difference at 1.2 MAC between the groups. These findings suggest that different inhalational anesthetics may have different effects on the BIS and the SEF 95.
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Randomized Controlled Trial Clinical Trial
[The effects of conscious sedation by propofol on respiration during abdominal hysterectomy under spinal anesthesia].
The effects of conscious sedation by propofol on respiration were studied in 28 patients undergoing abdominal hysterectomy under spinal anesthesia. The patients were randomly assigned to receive conscious sedation by propofol (Group P, n = 20) or no sedation (Group C, n = 8). After a satisfactory level of analgesia had been achieved, a loading dose of propofol, 0.2 mg.kg-1 was administered every minute in Group P until patients exhibited spontaneous eye closure or nystagmus. ⋯ Compared with Group C, the respiratory depression was less in Group P; SpO2 was significantly higher at 25 min after spinal tap and PETCO2 was significantly lower at 30 and 50 min after spinal tap in Group P. A score of patient satisfaction was significantly higher in Group P. Conscious sedation by propofol is a safe and useful supplement to spinal anesthesia for abdominal hysterectomy.
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ABC (angry backfiring C-nociceptor) syndrome-like pain disorder categorized in sympathetic independent pain appeared after amputation during spinal anesthesia. A 69-year-old female who had undergone amputation of the right leg below knee 5 months before, received amputation of the left leg below knee this time because of diabetic neuropathy and gangrene of her both legs. There were no complications in her right leg after the former amputation. ⋯ After changing the body position from left lateral to supine, the left leg was completely anesthetized and the right leg was incompletely anesthetized with only loss of cold sensation. In this state, she had pain in her right leg, and this pain was relieved by intravenous lidocaine administration. It was indicated that this type of pain was caused by the presence of ABC syndrome probably after right leg amputation.
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Case Reports
[Successful management of a patient who developed intra-operative pulmonary tumor embolism].
A 68-year-old female with retroperitoneal tumor extending into the inferior vena cava (IVC) developed massive pulmonary tumor embolism during removal of the tumor. Because of her unstable hemodynamics, emergency pulmonary embolectomy under cardiopulmonary bypass was performed. Successful management of her intra- and post-operative persistent right heart failure led to a satisfactory postoperative course without serious neurological complications. In peri-operative management of a patient with an extended tumor into IVC, prevention of the embolism, detection of the pulmonary embolism and treatment of intra- and post-operative right heart failure are important.